scholarly journals The additional value of lower respiratory tract sampling in the diagnosis of COVID-19. A single centre real life observational study.

2021 ◽  
Author(s):  
Luca Morandi ◽  
Francesca Torsani ◽  
Giacomo Forini ◽  
Marianna Padovani ◽  
Aldo Carnevale ◽  
...  
Keyword(s):  
North America ◽  
Respiratory Tract ◽  
Ct Scan ◽  
Lower Respiratory Tract ◽  
Clinical Symptoms ◽  
Standard Procedure ◽  
Laboratory Data ◽  
Real Life ◽  
Nasopharyngeal Swab ◽  
Radiological Society

Abstract Background: Since December 2019 SARS-CoV-2 has been identified as the causal agent for severe cases of pneumonia in China and it spread all over the world, putting great pressure on Health Systems. Despite regarded as the standard procedure, sensitivity of nasopharyngeal swab (NPS) is suboptimal. In clinical/radiological suspicion of SARS-CoV-2 infection despite negative NPS test, other tests may be required to rule out the infection. Objectives: To evaluate correlations between lower respiratory tract (LRT) testing for SARS-CoV-2 in suspect patients with 2 negative NPSs and clinical symptoms, laboratory values and the CT scan review score by the Radiological Society of North America. Method: Retrospective analysis of radiological, clinical and laboratory data from patients who underwent LRT sampling (blind nasotracheal aspiration or bronchial washing) for suspected COVID-19 after 2 negative NPS. Chest CTs were reviewed by two blinded radiologist using the Radiological Society of North America score for analysis purpose.Results: SARS-CoV-2 was detected in 7 out of 59 patients (11.9%). No clinical or laboratory value were found to correlate with positive test. CT scan showed good sensitivity (71.4%) and accuracy (81.3%), with a very high NPV (95.7%). Features scored as 'typical' showed good correlation with SARS-CoV2 detection on LRT. No complications nor staff’s infections were reported. Conclusions: In suspect cases with at least 2 negative swabs CT scan revision can be helpful in ruling out SARS-CoV-2 infection. In selected cases lower respiratory tract sampling can help in confirming COVID-19 in cases with consistent CT features.

scholarly journals Procalcitonin Correlates With but Is Not Superior to Other Diagnostic Markers of Bacterial Pneumonia

2020 ◽  
Author(s):  
Nadia Ayala-Lopez ◽  
David R Peaper ◽  
Roa Harb
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Bacterial Pneumonia ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Laboratory Data ◽  
Chest Imaging ◽  
Wbc Count ◽  
Tract Infections ◽  
Guided Therapy

Abstract Objectives Despite extensive research on procalcitonin (PCT)-guided therapy in lower respiratory tract infections, the association between PCT and bacterial pneumonia remains unclear. Methods We evaluated retrospectively the performance of PCT in patients presenting with lower respiratory tract infection symptoms and grouped by seven diagnoses. All patients had microbial testing, chest imaging, and CBC counts within 1 day of PCT testing. Results Median PCT level in patients diagnosed with bacterial pneumonia was significantly higher than in patients diagnosed with other sources of infections or those not diagnosed with infections. Median PCT levels were not different among patients grouped by type or quantity of pathogen detected. They were significantly higher in patients with higher pathogenicity scores for isolated bacteria, those with abnormal WBC count, and those with chest imaging consistent with bacterial pneumonia. A diagnostic workup that included imaging, WBC count, and Gram stain had an area under the receiver operating characteristic curve of 0.748, and the addition of PCT increased it to 0.778. Conclusions PCT was higher in patients diagnosed with bacterial pneumonia. Less clear is its diagnostic ability to detect bacterial pneumonia over and above imaging and laboratory data routinely available to clinicians.

scholarly journals Metapneumovirus infection in children

2020 ◽  
Vol 11 (5) ◽  
pp. 13-19
Author(s):  
Elena V. Sharipova ◽  
Irina V. Babachenko ◽  
Elizaveta D. Orlova
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Viral Infections ◽  
Clinical Symptoms ◽  
Hospitalized Children ◽  
Lower Respiratory Tract Infections ◽  
Nucleic Acid Isolation ◽  
Hmpv Infection ◽  
Tract Infections

Objective: to study the clinical features of metapneumovirus infection in children of different ages in a hospital. Materials and methods. A retrospective analysis of medical records of 142 patients aged 1 month to 14 years inclusive who were hospitalized in the period from January 2012 to April 2019. Metapneumovirus infection was confirmed by hMPV nucleic acid isolation by PCR in nasopharyngeal smears. Results. Metapneumovirus infection is detected among hospitalized children with acute respiratory viral infections in 4,4% of cases. In the age structure, 72,2% are children under 4 years old, and the maximum incidence rate is among children aged 3 years of life. The leading clinical symptoms are cough in 93,0% of cases and rhinitis in 96,5% of cases.In 88,2% of children, the disease proceeds with an increase in temperature 38 C, including in 34,6% 39,5 C and above. Symptoms of gastrointestinal dysfunction in the form of vomiting and diarrhea develop in 26,1% and 22,5% of children, respectively. 78,2% of patients requiring hospitalization suffer hMPV infection with damage to the lower respiratory tract, including in the form of bronchitis in 85,6% of cases and pneumonia in 14,4% of cases. The disease is complicated by the development of bronchial obstructive syndrome in 38,7% and acute respiratory failure in 22,3% of cases. ARF and BOS are significantly more likely to develop in children of the first 3 years of life 71,0% versus 29,0% in children of the older age group (p = 0.038) and 69,8% against 30,2% (p = 0.007), respectively. In a clinical blood test for hMPV infection, leukopenia and leukocytosis are detected only in 3,5% and 12,7% of cases, respectively, as well as an increase in ESR in 23,9% of children. The level of CRP in the 93,0% of children was less than 20 mg/l. Conclusions. Virological confirmation of metapneumovirus infection in hospitalized children with lower respiratory tract infections contributes to the formation of an adequate therapeutic tactic.

scholarly journals Peculiarities of the course of coronavirus infection COVID-19 in children of Ukraine

2021 ◽  
Vol 9 (2) ◽  
pp. 10-18
Author(s):  
O.K. Кoloskova ◽  
S.O. Kramarov ◽  
T.M. Bilous ◽  
L.A. Іvanova ◽  
T.M. Kaminska ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Clinical Symptoms ◽  
Gastrointestinal Symptoms ◽  
Patient Treatment ◽  
Upper Respiratory Tract ◽  
Reactive Protein ◽  
Increased Risk ◽  
Different Ages ◽  
Coronavirus Infection

Background. Pandemic of coronavirus disease COVID-19 caused by a new coronavirus SARS-CoV-2 still remains a global problem, but the data about the features of the course of COVID-19 infection among children of different ages are limited. The purpose was to conduct a generalized analysis of demographic, epidemiological and clinical features of COVID-19 in children of different ages from different regions of Ukraine. Materials and methods. In accordance with the principles of bioethics, a multicenter retrospective open cohort study of 669 cases of infection caused by coronavirus SARS-CoV-2 in children was conducted at the departments of hospital bases of Kyiv, Vinnytsia, Chernivtsi and Odesa. Clinical, laboratory and instrumental mar­kers of COVID-19 coronavirus infection were determined in hospitalized children. Results. The first (І) group included 67 infants under 2 months of age, the second (ІІ) one — 320 children aged from 60 days to 6 years, a subgroup of 127 patients of junior and middle school age formed the third (ІІІ) group, and the fourth (IV) group consisted of 155 adolescents at the age over 12. Damage to internal organs by SARS-CoV-2 virus was characterized by a multi-syste­mic type and manifested by changes in the upper respiratory tract in 70.1 % of cases, lower respiratory tract lesions — in 54.7 %, infectious and inflammatory changes — in 57.2 %, gastrointestinal symptoms — in 9.2 %, and neurological signs — in 17.8 % of observations. According to the results of study, the most frequent clinical symptoms found in the total cohort of patients were fever (51.1 %), general fatigue (51.6 %), sore throat (70.1 %), cough (54.7 %) and poor appetite (52.8 %). Damage to the lung parenchyma with specific clinical and radiological manifestations as a sign of coronavirus disease COVID-19 was detected in 23.9–25.9 % of children from the different regions of Ukraine, with a significantly increased risk of pneumonia among adolescents (odds ratio (OR) = 7.5). The most frequent changes when using additional methods of examination were leukocytosis (18.8 % of cases), thrombocytosis (14.5 %), leukopenia (11.1 %), increased С-reactive protein (43.7 %). Elevated content of platelets was mainly found in children of the first two months of life (38.3 % of cases), and it reliably increased during the period of in-patient treatment, which coincided with the tendencies to increasing the level of C-reactive protein in this age group (OR = 5.0). Conclusions. The analysis of epidemiological, clinical and laboratory features of the course of coronavirus disease caused by SARS-CoV-2 in children of different age groups from different regional hospital bases of Ukraine was consistent with the course in adult patients with COVID-19, but with higher chances of milder forms of the disease (OR = 3.1) among young children, and with involvement of the lower respiratory tract and higher risk of severe course among older children (OR = 7.3).

scholarly journals SARS-CoV-2 Detection in Fecal Sample from a Patient with Typical Findings of COVID-19 Pneumonia on CT but Negative to Multiple SARS-CoV-2 RT-PCR Tests on Oropharyngeal and Nasopharyngeal Swab Samples

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 290
Author(s):  
Barbara Brogna ◽  
Carlo Brogna ◽  
Mauro Petrillo ◽  
Adriana Modestina Conte ◽  
Giulio Benincasa ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Clinical Symptoms ◽  
Nasopharyngeal Swab ◽  
Upper Respiratory Tract ◽  
Rt Pcr ◽  
Chain Reaction ◽  
Negative Results ◽  
Upper Respiratory ◽  
Polymerase Chain ◽  
Pcr Test

Reverse transcriptase polymerase chain reaction (RT-PCR) negative results in the upper respiratory tract represent a major concern for the clinical management of coronavirus disease 2019 (COVID-19) patients. Herein, we report the case of a 43-years-old man with a strong clinical suspicion of COVID-19, who resulted in being negative to multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR tests performed on different oropharyngeal and nasopharyngeal swabs, despite serology having confirmed the presence of SARS-CoV-2 IgM. The patient underwent a chest computed tomography (CT) that showed typical imaging findings of COVID-19 pneumonia. The presence of viral SARS-CoV-2 was confirmed only by performing a SARS-CoV-2 RT-PCR test on stool. Performing of SARS-CoV-2 RT-PCR test on fecal samples can be a rapid and useful approach to confirm COVID-19 diagnosis in cases where there is an apparent discrepancy between COVID-19 clinical symptoms coupled with chest CT and SARS-CoV-2 RT-PCR tests’ results on samples from the upper respiratory tract.

scholarly journals Is secondary tracheomalacia associated with persistent lower respiratory tract inflammation and subclinical infection?

2020 ◽  
Author(s):  
Antonino Capizzi ◽  
Michela Silvestri ◽  
Giovanni Rossi ◽  
Oliviero Sacco
Keyword(s):  
Respiratory Tract ◽  
Haemophilus Influenzae ◽  
Ct Scan ◽  
Aortic Arch ◽  
Lower Respiratory Tract ◽  
Bacterial Load ◽  
Stable Condition ◽  
Innominate Artery ◽  
Vascular Anomalies ◽  
Subclinical Infection

Background. In secondary tracheomalacia due to mediastinal vascular anomalies one of the most prevalent symptom is recurrent lower respiratory tract (LRT) infections, related to defective airway clearance. Whether this condition could result in persistent LRT inflammation and subclinical infection is not known. Patients and methods. Children with tracheomalacia due to mediastinal vascular anomalies, recurrent (>3/y) LRT infections were evaluated while in stable condition. Computed tomography (CT) scan and bronchoscopy with bronchoalveolar lavage (BAL) were performed. Results. 31 children were included in the study: 21 with aberrant innominate artery (AIA), 4 with right aortic arch (RAA) and 1 with double aortic arch (DAA) and 5 with AIA associated with RAA. Cytological evaluation of BAL fluid showed increased neutrophil percentages and normal lymphocyte and eosinophil proportions. Microorganism growth was detected in 35.5% of BAL samples, with a bacterial load >105 colony-forming-units (CFU)/mL only in 10,2% of them. Most isolates were positive for Haemophilus influenzae, followed by Streptococcus pneumoniae, Group A β-hemolytic streptococci and Moraxella catarrhalis. Chest CT scan demonstrated the presence of bronchiectasis in 13% of the children, of which only one had a positive BAL culture for Haemophilus influenzae. Conclusions. Only in a small subgroup of children, persistent neutrophilic alveolitis was associated with a significant bacterial load and the presence of bronchiectasis. Because most pathogens detected in BAL samples cultures can produce biofilms, caution should be used in inappropriate antibiotic prescription in these patients that, chiefly in those with bronchiectasis, in which chest physiotherapy can be of great benefit.

scholarly journals C-reactive protein or procalcitonin combined with rhinorrhea for discrimination of viral from bacterial infections in hospitalized adults in non-intensive care units with lower respiratory tract infections

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shengchen Duan ◽  
Xiaoying Gu ◽  
Guohui Fan ◽  
Fei Zhou ◽  
Guangfa Zhu ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Tract ◽  
Bacterial Infection ◽  
Lower Respiratory Tract ◽  
Bacterial Infections ◽  
Clinical Characteristics ◽  
Clinical Symptoms ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Tract Infections

Abstract Background Whether procalcitonin (PCT) or C-reactive protein (CRP) combined with certain clinical characteristics can better distinguish viral from bacterial infections remains unclear. The aim of the study was to assess the ability of PCT or CRP combined with clinical characteristics to distinguish between viral and bacterial infections in hospitalized non-intensive care unit (ICU) adults with lower respiratory tract infection (LRTI). Methods This was a post-hoc analysis of a randomized clinical trial previously conducted among LRTI patients. The ability of PCT, CRP and PCT or CRP combined with clinical symptoms to discriminate between viral and bacterial infection were assessed by portraying receiver operating characteristic (ROC) curves among patients with only a viral or a typical bacterial infection. Results In total, 209 infected patients (viral 69%, bacterial 31%) were included in the study. When using CRP or PCT to discriminate between viral and bacterial LRTI, the optimal cut-off points were 22 mg/L and 0.18 ng/mL, respectively. When the optimal cut-off for CRP (≤ 22 mg/L) or PCT (≤ 0.18 ng/mL) combined with rhinorrhea was used to discriminate viral from bacterial LRTI, the AUCs were 0.81 (95% CI: 0.75–0.87) and 0.80 (95% CI: 0.74–0.86), which was statistically significantly better than when CRP or PCT used alone (p < 0.001). When CRP ≤ 22 mg/L, PCT ≤ 0.18 ng/mL and rhinorrhea were combined, the AUC was 0.86 (95% CI: 0.80–0.91), which was statistically significantly higher than when CRP (≤ 22 mg/L) or PCT (≤ 0.18 ng/mL) was combined with rhinorrhea (p = 0.011 and p = 0.021). Conclusions Either CRP ≤ 22 mg/L or PCT ≤ 0.18 ng/mL combined with rhinorrhea could help distinguish viral from bacterial infections in hospitalized non-ICU adults with LRTI. When rhinorrhea was combined together, discrimination ability was further improved.

scholarly journals TRACHEOBRONCHOMEGALIE OU SYNDROME DE MOUNIER-KUHN

2020 ◽  
Vol 8 (9) ◽  
pp. 952-954
Author(s):  
Ayman El Farouki ◽  
◽  
Habib Bellamlih ◽  
Hounayda Jerguigue ◽  
Rachida Latib ◽  
...  
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Ct Scan ◽  
Respiratory Tract Infection ◽  
Chronic Cough ◽  
Lower Respiratory Tract ◽  
Spontaneous Pneumothorax ◽  
Rare Condition ◽  
The Third ◽  
Large Airways

Mounier-kuhn Syndrome or The Tracheobronchomegaly is a rare condition characterized by marked dilatation of the trachea and the main bronchi. It is more common in males and diagnosed in the third and the fourth decades of life. Symptoms in MKS are nonspecific. Usually the patient present recurrent lower respiratory tract infection, chronic cough, and rarely with spontaneous pneumothorax. Patients are often diagnosed on CT scan, which shows large airways with sometimes the formation of diverticula in the major airways. We report the case of a patient who presented with aMounier-Kuhn Syndrome revealed by respiratory recurrent symptoms.

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